疑似喉咽反流病患者质子泵抑制剂的撤药

Weaning of proton pump inhibitors in patients with suspected laryngopharyngeal reflux disease.

作者信息

Lin R Jun, Sridharan Shaum, Smith Libby J, Young VyVy N, Rosen Clark A

机构信息

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington DC, U.S.A.

出版信息

Laryngoscope. 2018 Jan;128(1):133-137. doi: 10.1002/lary.26696. Epub 2017 Jul 21.

DOI:10.1002/lary.26696

PMID:28730666

Abstract

OBJECTIVE

To evaluate the feasibility of a proton pump inhibitor (PPI) weaning protocol in a cohort of patients following successful empiric treatment for suspected laryngopharyngeal reflux disease (LPRD).

STUDY DESIGN

Retrospective chart review.

METHODS

LPRD patients were weaned from PPIs using a standardized weaning protocol. Symptom recurrence rate following PPI wean and present PPI use were determined. All numeric data were analyzed. The setting was a tertiary laryngology practice. The subjects were patients who had a positive response to empiric treatment for LPRD and subsequently were weaned from PPI therapy.

RESULTS

Thirty-five patients with suspected LPRD were instructed to wean from PPI after successful empiric treatment of their LPRD symptoms from July 2013 to September 2015. Twenty-three patients (66%) remained symptom-free post-wean. Twelve patients (34%) had symptom recurrence post-wean; of those, 11 of them (92%) needed to go back on a PPI. Median durations of follow-up for the unsuccessful wean group and the successful wean group were 13 (range 6-29) months and 18 (range 6-38) months, respectively. Pre-wean and post-wean reflux symptom index (RSI) scores in the unsuccessful wean group were 7.7 ± 5.6 and 12.9 ± 6 (P = .11). Pre-wean and post-wean RSI scores in the successful wean group were 8.1 ± 6.5 and 8.1 ± 9.0 (P < .99). Body mass index (BMI) was found to be a significant predictor of failure to wean (odds ratio = 0.72, 95% confidence interval = 0.55-0.95) after controlling for age, sex, PPI treatment duration, and PPI regime. None of the other covariates were found to be significant predictors of failure of PPI wean.

CONCLUSION

Approximately 66% of patients who were on PPIs for LPRD were successfully weaned. High BMI was significantly predictive of failure to wean.

LEVEL OF EVIDENCE

Laryngoscope, 128:133-137, 2018.

摘要

目的

评估质子泵抑制剂（PPI）撤药方案在一组疑似喉咽反流病（LPRD）经验性治疗成功后的患者中的可行性。

研究设计

回顾性病历审查。

方法

采用标准化撤药方案使LPRD患者停用PPI。确定PPI撤药后的症状复发率及目前PPI的使用情况。对所有数值数据进行分析。研究地点为一家三级喉科诊所。研究对象为对LPRD经验性治疗有阳性反应且随后停用PPI治疗的患者。

结果

2013年7月至2015年9月，35例疑似LPRD患者在其LPRD症状经验性治疗成功后被指示停用PPI。23例患者（66%）撤药后无症状复发。12例患者（34%）撤药后症状复发；其中11例（92%）需要重新使用PPI。撤药失败组和成功组的中位随访时间分别为13（范围6 - 29）个月和18（范围6 - 38）个月。撤药失败组撤药前和撤药后的反流症状指数（RSI）评分分别为7.7±5.6和12.9±6（P = 0.11）。撤药成功组撤药前和撤药后的RSI评分分别为8.1±6.5和8.1±9.0（P < 0.99）。在控制年龄、性别、PPI治疗持续时间和PPI用药方案后，发现体重指数（BMI）是撤药失败的显著预测因素（比值比 = 0.72，95%置信区间 = 0.55 - 0.95）。未发现其他协变量是PPI撤药失败的显著预测因素。